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AA key priority of the Prescription Drug Abuse Prevention Task Force is advancing legislation to help combat the problem of prescription drug abuse and diversion. The committees that comprise the Rx Task Force are committed to studying and developing policies aimed to reduce the devastating impact prescription drug abuse has on Hoosier families and communities. Click on the links below to view state legislation that has been implemented as a result of these efforts.
SB187 - Overdose Intervention Drugs
Effective July 1, 2016. This bill requires an entity acting under a standing order issued by a prescriber for an overdose intervention drug to report annually certain information to the state department of health. Requires the state department to ensure that a statewide standing order for the dispensing of an overdose intervention drug is issued for Indiana. Allows the state health commissioner or a public health authority to issue a statewide standing order for the dispensing of an overdose intervention drug. Requires certain emergency ambulance services responsible for submitting the report to report the number of times an overdose intervention drug has been administered. Requires the ambulance service to include the information in the emergency ambulance service's report to the emergency medical services commission under the emergency medical services system review. Provides that, if certain conditions are met, an individual who aided an individual in need of medical assistance due to an opioid related overdose is immune from certain criminal prosecutions.
SB297 - Opioid Dependence Treatment
This will was signed by the Governor on March 21, 2016 and becomes effective on July 1, 2016. The Opioid Dependence Treatment bill requires Medicaid coverage for inpatient detoxification for the treatment of opioid or alcohol dependence. Add requirements for an opioid treatment program to meet in order to operate in Indiana. Requires the division of mental health and addiction to adopt specified treatment protocol containing best practice guidelines for the treatment of opiate dependent patients to be used by certain office based opioid treatment providers. Requires an opioid treatment program to provide specified information upon request by the division. Urges the legislative council to assign a study committee the topic of patient access to and provider reimbursement for federally approved medication assisted treatment in the Medicaid program. For a more comprehensive summary, please click here.
HB1278 - INSPECT Program
Effective July 1, 2016. This bill allows a dentist, physician, advanced practice nurse, physicians assistant and podiatrist to include an INSPECT program report in a patient's file. Establishes requirements to obtain reciprocity for an out-of-state person seeking to provide home medical equipment services in Indiana. Removes a provision that allows the pharmacy board to adopt rules for an out-of-state person seeking to provide home medical equipment services in Indiana. Allows an individual who holds a temporary fellowship permit to access the INSPECT program. Allows a county coroner conducting a medical investigation of the cause of death to access the INSPECT program. Makes certain changes to the immunity granted to practitioners who use the INSPECT program. (Current law extends immunity to both practitioners who use and do not use the INSPECT program.) Allows a practitioner's agent to check INSPECT program reports on behalf of the practitioner. Allows a patient to access an INSPECT program report that is in the patient's medical file. Requires the boards that regulate health care providers that prescribe or dispense prescription drugs to establish prescribing norms and dispensing guidelines that, if exceeded, justify the unsolicited dissemination of exception reports. Specifies the exception reports that a board's designee may forward to a law enforcement agency or the attorney general for purposes of an investigation. Makes a technical correction.
SB214 - Controlled Substances Reimbursement
Effective July 1, 2016. This bill prohibits Medicaid reimbursement for Subutex, Suboxone, or a similar trade name or generic of the drug if the drug was prescribed for the treatment of pain or pain management and the drug is only indicated for addiction treatment. Requires the office of the secretary and the division of mental health and addiction to develop a treatment protocol containing best practice guidelines for the treatment of opiate dependent patients to be used by certain office based opioid treatment providers. Requires the office of the secretary to recommend certain best practice guidelines to: (1) the professional licensing agency; (2) the office of Medicaid policy and planning; and (3) a managed care organization that has contracted with the office.
HB1347 - Mental Health Matters
Effective July 1, 2016. This bill requires the office of Medicaid policy and planning to reimburse under the Medicaid program: (1) certain advanced practice nurses for specified Medicaid services; (2) certain graduate and post graduate degree level students in specified fields who are interning or in a practicum at a community mental health center under the direct supervision of a licensed professional; and (3) licensed clinical addiction counselors who under the clinical supervision of a physician or health service provider in psychology. Requires the department of insurance, in consultation with the office of the secretary of family and social services, to review, study, and make recommendations concerning the capacity, training and barriers to health navigators in assisting individuals in obtaining health insurance program coverage. Requires the department to report their findings to the interim study committee on public health, behavioral health and human services before September 30, 2016.
This bill became effective on April 17, 2015, when signed by the Governor. Requires certain emergency personnel to report to the state department of health the number of times an overdose intervention medication is administered. Allows specified health care professionals with prescriptive authority to dispense, write a prescription, or prepare a standing order for an overdose intervention drug without examining the individual to whom it may be administered if specified conditions are met. Allows for an individual who is a person at risk, a family member, friend, or other individual or entity in a position to assist another individual who, there is reason to believe, is at risk of experiencing an opioid-related overdose, to obtain and administer an overdose intervention drug if certain conditions are met. Provides for civil immunity.
Effective July 1, 2015. Rules for prescribing controlled substances. Requires the medical licensing board to adopt standards and protocols for the prescribing of abuse deterrent formulations. Requires, before March 1, 2016, the following boards to adopt rules concerning the prescribing of opioid controlled substances for pain management treatment: (1) the medical licensing board, concerning physician assistants; (2) the board of podiatric medicine, concerning podiatrists; (3) the state board of dentistry, concerning dentists; and (4) the Indiana state board of nursing, concerning advanced practice nurses. Requires each board to report before December 31, 2015, to the legislative council with a status report on the board's efforts to adopt the required rules.
Effective upon signature of Governor which was 5-4-15. Sets forth conditions in which a local health department, a municipality, a county, or a nonprofit organization may operate a syringe exchange program and expires the authorization of a program July 1, 2019. Before a qualified entity may operate a SEP, the local health officer or executive director must declare to the executive body of the county or legislative body the following: A) There is an epidemic of hepatitis C or HIV; B) that the primary mode of transmission of hep C or HIV in the county is through IV drug use; C) That a SEP is medically appropriate as part of a comprehensive public health response.
Effective July 1, 2015. Provides that addiction counseling, inpatient detoxification, case management, daily living skills, and long acting, non-addictive medication may be required to treat opioid or alcohol addiction as a condition of parole, probation, community corrections, pretrial diversion, or participation in a problem solving court. Requires coverage under the Indiana check-up plan of non-addictive medication assistance treatment drugs prescribed for the treatment of substance abuse. Authorizes the division of mental health and addiction (division) to approve before June 30, 2018, not more than five new opioid treatment programs if: (1) the programs are run by a hospital, a specified institution, or a certified community mental health center; and (2) the division determines that there is a need for a new opioid treatment program in the proposed location. Requires a prescriber who is prescribing methadone for the treatment of pain or pain management to indicate this treatment on the prescription or order. Establishes the mental health and addiction forensic treatment services account (account) within the statutes governing the division, rather than the statutes governing corrections (under current law). Provides that the division may use money in the account to fund grants and vouchers that are provided to the following for mental health and addiction forensic treatment services: (1) Community corrections programs. (2) Court administered programs. (3) Probation and diversion programs. (4) Community mental health centers. (5) Certified mental health or addiction providers. Allows the division to use money in the account as a state match under the Medicaid rehabilitation program and the Primary Health Coordination Program. Requires the division to provide an education and training program concerning involuntary commitment and medication assisted treatment. Specifies that an individual is eligible for such mental health and addiction forensic treatment services if the individual meets certain criteria and if reimbursement for the service is not available to the individual under a health insurance policy, a health maintenance organization contract, the Medicaid program, the Medicare program, or any other federal assistance program. Requires the division to survey and develop demographic research on individuals receiving services. Places restrictions on coverage under a health insurance policy and a health maintenance organization contract for methadone used in pain management.
Signed by Governor on 4-30-15. Establishes the INSPECT Oversight Committee. Provides the committee's approval for the board to execute a contract with a vendor to administer the INSPECT program. Requires approval from the chairperson of the board of pharmacy to hire a director of the INSPECT program. Provides that if a dispenser's pharmacy is closed the day following a dispensing, the information required to be sent to the INSPECT program must be transmitted by the end of the next business day. Amends the definition of "medication assistance" in the administrative code for purposes of the rules concerning home health agencies.
Effective July 1, 2015. Includes inpatient substance abuse detoxification services as a Medicaid service. Authorizes the office of Medicaid policy and planning to require prior authorization for addictive medication used as medication assisted treatment for substance abuse. Allows money in the forensic treatment services account to be used to fund grants and vouchers for licensed mental health or addiction providers. Requires information and training to judges, prosecutors, and public defenders concerning diversion programs, probationary programs, and involuntary commitment.
Effective July 1, 2015. $30 Million was appropriated to the Mental Health and Addiction Forensic Treatment Services account that is to be administered by the Division of Mental Health and Addiction (DMHA) with FSSA. DMHA shall give priority in awarding funding to programs that provide evidence based treatment for mental health and addiction or cognitive behavior intervention directly to individuals.
Effective July 1, 2015. Provides that addiction counseling, inpatient detoxification, and the administration of a federal Food and Drug Administration (FDA) approved, non-addictive medication for alcohol or opioid treatment may be required to treat opioid or alcohol addiction as a condition of parole, probation, community corrections, pretrial diversion, or participation in a problem solving court. Provides that the division of mental health and addiction may consider the administration of an FDA approved, non-addictive medication for alcohol or opioid treatment as an alternative to methadone treatment. Repeals provisions allowing juvenile courts to modify disposition orders concerning truancy and runaways. Allows drug abusers or alcoholics charged with or convicted of certain felonies to request treatment for addictions. Provides that a convicted individual may be placed on probation if the individual requests to undergo substance abuse treatment. Provides for voluntary and involuntary treatment for drug addictions. Allows an alcohol and drug services program or the clerk of a court to collect fees concerning court established alcohol and drug services programs.
House Resolution 71 Resolution to the General Assembly that would request the federal centers for Medicare and Medicaid Services to revise survey measures included in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS),
Press Release – New laws will fight human trafficking, provide addiction treatment
Originally passed in 2012 at the urging of college students, the Lifeline Law encourages young people to call 911 if someone suffers alcohol poisoning and makes the caller immune from criminal charges related to underage drinking. Attorney General Zoeller has promoted awareness of the Lifeline Law at campuses with the Lifeline Law's author, State Sen. Jim Merritt, R-Indianapolis. This year, Sen. Merritt authored Senate Enrolled Act 227, an update to the Lifeline Law that expands it to extend immunity from prosecution if underage callers seek help for other types of medical emergencies such as concussions or if they are a victim of a sexual assault, or witness and report a crime. Zoeller recommended an amendment to SEA 227 that encourages first responders – including law enforcement and firefighters – to be equipped with Naloxone, a medication that counteracts the effects of an opioid drug overdose. It will remove legal barriers to first responders utilizing the antidote to save patients’ lives. SEA 227 also authorizes a legislative study committee to study the topic of human trafficking facilitated on the Internet.
Intended to deter prescription drug abuse that might be facilitated by overprescribing by providers, the Indiana Scheduled Prescription Electronic Collection and Tracking Program, or INSPECT, is a database the state has operated for several years that tracks the dispensing of certain addictive controlled substances. So that the database is kept updated in a timely manner, the task force recommended House Enrolled Act 1218, which requires pharmacists to provide dispensing information to INSPECT on certain opioid drugs – within three days, starting July 1, 2015, and within 24 hours, starting January 1, 2016. HEA 1218 includes patient privacy protections for confidentiality.
Mindful of patients already addicted, another of the task force’s recommendations was to address Indiana’s shortage of mental health professionals and addiction treatment professionals. To encourage more of these professionals to practice in Indiana, House Enrolled Act 1360 offers up to five years of student loan forgiveness grants to psychiatrists, psychologists, psychiatric nurses, addiction counselors and mental health professionals who are pursuing addiction training in behavioral health and addiction psychiatry -- provided they practice their specialty within the state.
The task force also reviewed the problem of Neonatal Abstinence Syndrome or NAS, where newborns exposed to prescription or illicit drugs while in the womb suffer from withdrawal symptoms including respiratory complications, low birth weight, feeding difficulties and seizures. Senate Enrolled Act 408 establishes a standard clinical definition of Neonatal Abstinence Syndrome, and directs the Indiana State Department of Health (ISDH) to meet with various medical and pediatric stakeholders, to develop recommendations regarding diagnosis and screening and reporting of statistics of NAS that will be presented to the Legislative Council no later than November 1, 2014. SEA 408 allows ISDH before June 1, 2015, to establish pilot programs with hospitals to put the NAS recommendations into practice.
State Senator Ron Grooms, R- Jeffersonville, and State Representative Steve Davisson, R- Salem, members of the Prescription Drug Abuse Task Force, helped author and sponsor key legislation that will help in the fight against prescription drug abuse.
Senate Enrolled Act 246 makes important changes regarding clinics that prescribe, dispense or administer controlled substances. It requires clinic owners to hold an Indiana Controlled Substance Registration (CSR). Clinic owners have a responsibility for overseeing the operations in the clinic and ensuring that practitioners prescribe in a way that complies with the law. The law also allows the Attorney General’s office to move more quickly in taking enforcement action against practitioners who overprescribe and obtain records for an inves
House Enrolled Act 1465 improves the effectiveness of the Indiana Scheduled Prescription Electronic Collecting & Tracking program (INSPECT), the state’s prescription drug monitoring program. INSPECT maintains a database of controlled substances dispensed by pharmacies, and physician can access the program to verify they are not overprescribing to an addicted patient who might be drug-seeking.